Hae-Kag Lee

Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: A meta-analysis

BACKGROUND The impact of intraoperative rupture on prognosis is controversial in early-stage epithelial ovarian cancer (EOC). Thus, we performed a meta-analysis to determine its impact and to evaluate factors to increase its risk. METHODS We searched PubMed, Embase, and the Cochrane Library till May 2011, and 9 eligible studies including 2382 patients were evaluated. All patients were classified into three groups: no rupture; intraoperative rupture; preoperative involvement. RESULTS Preoperative involvement decreased progression-free survival when compared with intraoperative rupture (PFS; HR, 1.47; 95% CI, 1.01-2.14), which also showed poorer PFS than no rupture (HR, 2.41; 95% CI, 1.74-3.33). Although preoperative involvement reduced PFS when compared with intraoperative rupture (HR, 2.63; 95% CI, 1.11-6.20), there was no difference in it between intraoperative rupture and no rupture in patients who underwent complete surgical staging operation and adjuvant platinum-based chemotherapy if needed (HR, 1.49; 95% CI, 0.45-4.95). Furthermore, adhesion to adjacent tissues, grade 2 or 3 disease were more common (ORs, 2.01 and 2.47; 95% CIs, 1.20-3.37 and 1.12-5.46), whereas mucinous tumor was less frequent (OR, 0.51; 95% CI, 0.37-0.72) in intraoperative rupture than in no rupture. CONCLUSIONS Intraoperative rupture may not decrease PFS when compared with no rupture in patients with early-stage EOC who underwent complete surgical staging operation and adjuvant platinum-based chemotherapy. Furthermore, more adhesion to adjacent tissues and grade 2 or 3 disease, and less mucinous tumor are expected to increase the risk of intraoperative rupture.

Factor Analysis of Biochemical Markers Associated with Bone Mineral Density in Adults

[Purpose] The aim of this study was to find biochemical markers related to low bone mineral density in Korean adults. [Subjects and Methods] From August 1 to September 15, 2013, subjects receiving medical checkups were classified as lumbar spine bone normal, osteopenic, or osteoporotic using a bone mineral densitometer. Next, age, body mass index, and biochemical parameter differences were compared among the three groups. [Results] The results revealed that, the relevant factors were maximum blood pressure, minimum blood pressure, bone mineral density, total bilirubin, alkaline phosphatase (ALP), fasting blood glucose, iron, neutrophils, monocytes, and eosinophils. The bone mineral density of patients with osteoporosis was 0.763 times lower than that of normal subjects. The total bilirubin level of patients with osteoporosis was 0.45 times lower than that of normal subjects. The alkaline phosphatase level of patients with osteopenia was 1.059 times higher than that of normal subjects, and that in patients with osteoporosis was 1.088 times higher than that in normal subjects. The fasting blood glucose level of patients with osteoporosis was 0.963 times lower than that of normal subjects. The iron level of patients with osteoporosis was 0.986 times lower than that of normal subjects. [Conclusion] In conclusion, osteoporosis is a representative disease in elderly women due to aging and menopause, and more active interest should be taken for prevention and treatment.

Quantitative comparison of transient elastography (TE), shear wave elastography (SWE) and liver biopsy results of patients with chronic liver disease.

[Purpose] The purpose of this study was to carry out a comparitive analysis of hepatic fibrosis results of the liver hardness of patients with chronic liver disease as measured by elastography (TE), shear wave elastography (SWE), and liver biopsy. [Subjects and Methods] This study was a retrospective analysis of 304 patients who underwent SWE and TE before and after liver biopsy, taken from among patients who had been checked for liver fibrosis by liver biopsy between August 2013 and August 2014. We used receiver operating characteristic (ROC) curve to prove the diagnostic significance of liver stiffness, and then analyzed the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and TE, as well as the kappa index through cross-analysis of SWE, TE, and liver biopsy. [Results] For liver hardness, the sensitivity of SWE was 84.39%, the specificity of SWE was 97.92%, the accuracy of SWE was 87.33%, the positive predictive value of SWE was 99.32%, and the negative predictive value of SWE was 63.51%. The sensitivity of TE was 94.80%, the specificity of TE was 77.08%, the accuracy of TE was 90.95%, the positive predictive value of TE was 93.97%, and the negative predictive value of TE was 80.43%. [Conclusion] It is our opinion that SWE and TE are non-invasive methods that are more effective than the invasive methods used for diagnosing liver hardness. Invasive methods cover only a section of liver tissue, and are more likely to cause side effects during biopsy.

Analysis of the relationship between liver regeneration rate and blood levels.

Objectives: The aim of this study was to investigate the difference of liver function changes according to the liver regeneration rate after liver transplantation through blood tests. Methods: Fifty donors, who underwent computed tomography (CT) 3D volumetry, were analyzed before and after liver transplantation. CT 3D volumetry was used as a study method to measure the mean liver regeneration volume and regeneration rate. Then, blood levels were measured including alanine transaminase (ALT), aminotransferase (AST), gamma-glutamyl transpeptidase (GGT) and total bilirubin. Results: The liver regeneration rate rapidly increased from 39.13±4.91% befoone1 month and 90.31±13.09% 16 months after surgery furthermore. Blood levels rapidly increased 7 days after surgery and then decreased 16 months after surgery compared to the state before surgery. Conclusion: This study results could be used as a basis for the prognosis of future liver transplantations.

A study on the relationship between stress and fatigue and the musculoskeletal symptoms experienced by Korean radiation workers.

[Purpose] The purpose of this study was to examine the relationship between factors such as stress and fatigue on musculoskeletal symptoms experienced by radiologists who were working in clinics and hospitals. [Subjects and Methods] A survey was conducted for radiologists in clinics, general hospitals, and university hospitals across the nation in a 20-day period from July 10–31, 2011. [Results] According to the comprehensive results of this study, job stress, psychosocial stress, and fatigue felt by radiologists had impacts on musculoskeletal disease in multiple body regions. First, according to the analysis results, job stress was scored at 2.48 on average on a 4-point Likert scale, while psychosocial stress was scored at 2.27 on average on the same scale, which demonstrated that job stress had a slightly higher score than psychosocial stress. Second, job stress, psychosocial stress, and fatigue had impacts on musculoskeletal symptoms experienced by radiologists; the possibility of musculoskeletal symptoms on the neck area increased as the physical environment got worse, interpersonal conflicts got serious, stress from organizational system increased, and psychosocial stress went up. [Conclusion] We expect that the results of this study would be useful as basic data for systematic and efficient management of resources when taking preventative measures against musculoskeletal disease experienced by radiologists in the future.

Analysis of Biochemical Markers Related to Fatty Liver Patients

[Purpose] This study was designed to study the correlation between biochemical tests and fatty liver. [Subjects and Methods] The study subjects were 242 people who received an abdominal ultrasound examination at a general hospital in Seoul, Korea, from March 2012 to March 2013. After the abdominal ultrasound examination, the subjects were categorized according to the presence or absence of fatty liver (n = 118 and 124, respectively). [Results] Comparison of biochemical markers revealed that glucose, total protein, aspartate transminase, alanine transaminase and triglyceride were higher in fatty liver patients. Risk analysis of general characteristics determined that hypertensive and diabetic patients had a 2.475- and 2.026-times greater risk of onset of fatty liver, respectively. The comparison of fatty liver with individual characteristics and biochemical markers revealed a 1.804-times greater chance of fatty liver when total protein was high, 0.964-times greater chance when high density lipoprotein was elevated and 1.204-times greater chance when triglyceride was elevated. When hypertension became severe, the chance of experiencing onset of fatty liver was 2.848 times higher. [Conclusion] Fatty liver is a representative disease of obese people in general and more active attention is necessary for its prevention and treatment. A direct cause of fatty liver was not found. Large-scale prospective studies will be required.

A Study on Effective Source-Skin Distance using Phantom in Electron Beam Therapy

In this study, for 6-20 MeV electron beam energy occurring in a linear accelerator, the authors attempted to investigate the relation between the effective source-skin distance and the relation between the radiation field and the effective source-skin distance. The equipment used included a 6-20 MeV electron beam from a linear accelerator, and the distance was measured by a ionization chamber targeting the solid phantom. The measurement method for the effective source-skin distance according to the size of the radiation field changes the source-skin distance (100, 105, 110, 115 cm) for the electron beam energy (6, 9, 12, 16, 20 MeV). The effective source-skin distance was measured using the method proposed by Faiz Khan, measuring the dose according to each radiation field (6 × 6, 10 × 10, 15 × 15, 20 × 20 ㎠) at the maximum dose depth (1.3, 2.05, 2.7, 2.45, 1.8 cm, respectively) of each energy. In addition, the effective source-skin distance when cut-out blocks (6 × 6, 10 × 10, 15 × 15 cm2) were used and the effective source-skin distance when they were not used, was measured and compared. The research results showed that the effective source-skin distance was increased according to the increase of the radiation field at the same amount of energy. In addition, the minimum distance was 60.4 cm when the 6 MeV electron beams were used with 6 × 6 cut-out blocks and the maximum distance was 87.2 cm when the 6 MeV electron beams were used with 20 × 20 cut-out blocks; thus, the largest difference between both of these was 26.8 cm. When comparing the before and after the using the 6 × 6 cut-out block, the difference between both was 8.2 cm in 6 MeV electron beam energy and was 2.1 cm in 20 MeV. Thus, the results showed that the difference was reduced according to an increase in the energy. In addition, in the comparative experiments performed by changing the size of the cut-out block at 6 MeV, the results showed that the source-skin distance was 8.2 cm when the size of the cut-out block was 6 × 6, 2.5 cm when the size of the cut-out block was 10 × 10, and 21.4 cm when the size of the cut-out block 15 × 15. In conclusion, it is recommended that the actual measurement is used for each energy and radiation field in the clinical dose measurement and for the measurement of the effective source-skin distance using cut-out blocks.

Accuracy Analysis of Magnetic Resonance Angiography and Computed Tomography Angiography Using a Flow Experimental Model

This study investigated the accuracy of magnetic resonance angiography (MRA) and computed tomography angiography (CTA) in terms of reflecting the actual vascular length. Three-dimensional time of flight (3D TOF) MRA, 3D contrast-enhanced (CE) MRA, volume-rendering after CTA and maximum intensity projection were investigated using a flow model phantom with a diameter of 2.11 mm and area of 0.26 ㎠. 1.5 and 3.0 Tesla devices were used for 3D TOF MRA and 3D CE MRA. CTA was investigated using 16 and 64 channel CT scanners, and the images were transmitted and reconstructed by volume-rendering and maximum intensity projection, followed by conduit length measurement as described above. The smallest 3D TOF MRA measure was 2.51 ± 0.12 ㎜ with a flow velocity of 40 cm/s using the 3.0 Tesla apparatus, and 2.57 ± 0.07 ㎜ with a velocity of 71.5 ㎝/s using the 1.5 Tesla apparatus; both images were magnified from the actual measurement of 2.11 ㎜. The measurement with the 16 channel CT scanner was smaller (3.83 ± 0.37 ㎜) than the reconstructed image on maximum intensity projection. The images from CTA from examination apparatus and reconstruction technique were all larger than the actual measurement.

Influence of Iodinated Contrast Media and Paramagnetic Contrast Media on Changes in Uptake Counts of 99m Tc

The purpose of this study is to figure out how uptake counts of technetium ( 99m Tc) among radioisotopes in the human body are affected if computed tomography (CT), magnetic resonance imaging (MRI) and isotope examination are performed consecutively. 99m Tc isotope material, iodinated contrast media for CT and paramagnetic contrast media for magnetic resonance (MR) were used as experimental materials. First, 99m Tc was added to 4 cc normal saline in a test tube. Then, 2 cc of CT contrast media such as Iopamidol ® and Dotarem ® were diluted with 2 cc normal saline, and 2cc of MRI contrast media such as Primovist ® and Gadovist ® were diluted with 2 cc normal saline. Each distributed contrast media was a total of 4 cc and included 10m Ci of 99m Tc. A gamma camera, a LEHR (Low energy high resolution) collimator and a pin-hole collimator were used for image acquisition. Image acquisition was repeated a total of 6 times and 120 frames were obtained and uptake counts of 99m Tc were measured (from this procedure). In this study, as a result of measuring the uptake counts of 99m Tc using the LEHR collimator, the uptake counts were less measured in all contrast media than normal saline as a reference. In particular, the lowest uptake counts were measured when Gadovist ® , contrast media for MRI, was used. However, the result of measuring the uptake counts of 99m Tc using the pin-hole collimator showed higher uptake counts in all contrast media, except for Iopamidol ® , than normal saline as a reference. The highest uptake counts were measured particularly when Primovist ® , contrast media for MRI, was used. In performing the gamma camera examination using contrast media and 99m Tc, it is considered significant to check the changes in the uptake counts to improve various diagnosis values.

How Computed Tomography Contrast Media and Magnetic Resonance Imaging Contrast Media Affect the Changes of Uptake Counts of 201 Tl

The purpose of the study is to investigate how uptake counts of 201 Tl of radioisotopes in the human body could change, when taking computed tomography and magnetic resonance imaging right after injecting contrast media. 201 Tl radioisotope substances of iodine contrast medium, which is a computed tomography contrast medium, and paramagnetic contrast medium, which is an magnetic resonance imaging contrast medium, were used as study materials. First, 201 Tl was put into 4 cc of normal saline in test tube, and then a computed tomography contrast medium of Iopamidol ® or Dotarem ® , was put into 2 cc of normal saline in test tube. An magnetic resonance imaging contrast medium of Primovist ® or Gadovist ® was also put into 2 cc of normal saline in test tube. Each contrast medium was distributed to make 201 Tl as 3 mCi, with a total of 4 cc. Gamma camera, low energy high resolution collimator, and pinhole collimator were used to obtain images. The uptake count of 201 Tl was measured with 1000 frames of images, and obtained after 10 times of repetition. This study revealed that the use of Gadovist ® , which is an magnetic resonance imaging contrast medium, showed the smallest number of uptake count, after measuring 201 Tl uptake count by low energy high resolution collimator. On the other hand, the use of Iopamidol ® , which is a computed tomography contrast medium, showed the biggest difference in uptake count, when measuring 99m Tc uptake count by Pinhole collimator. When examining with gamma camera, using contrast medium and 201 Tl, identifying the changes of uptake count is very important for improving the value of diagnosis.